Irene

Psycho-pathological symptoms:

- Decline in memory/Dementia (Patient forgot her relation to her granddaughter, forgot that she had
to go to South Parks nursing home, thought she had to go to France, kept asking if she picked her
makeup when leaving, thought she was gone from home for longer than one week, then forgot she
went to South Parks at all and forgot her birthday was being celebrated)
- Decline in thinking and judgement (Patient didn’t understand why she had to go to nursing home,
thinks she is capable of being by herself as long as she had food)
- Loss of emotional control (Patient got upset when told she had to leave for south parks, at one
instance she also got a bit angry, insisting she did not want to go. Patient then said she didn’t want
to live any longer

(Cognitive disturbances):

- May have apraxia (Patient was unable to pack her things when she had to leave for the nursing
home, despite being asked to by her daughter several times. Patient wanted to pick up her
belongings, especially makeup but seemed unable to)
- Disturbed executive functioning (Patient was unable to understand and plan for her leave to South
Parks, was unable to pack for it)

Patient has very little insight to her condition as she recognised that she was unfit to travel to France, yet did
not understand why it was necessary for her to go to the nursing home and believed she was capable of
taking care of herself alone.

Pharmacological treatment:

Patients with Alzheimer’s disease are usually given cholinesterase inhibitors.

For this patient, we could give her donepezil, starting with 5mg and slowly increase if symptoms do not
improve. If the patient’s dementia does not improve, we can switch to memantine, starting with a dose of
5mg, and slowly increase according to need.

Nonpharmacological treatment:
There are plenty of approaches that can be taken, taking the patient’s severity of Alzheimer’s into
consideration. In case of Irena, since her family is unable to take care of her 24/7 and do not think she can
live alone, she should be placed in a nursing home where someone can watch over her.
Furthermore, the patient can undergo cognitive stimulation to improve her general cognitive abilities, as well
as take part in activities that she enjoys and keep her busy.
Her family can also consider not pushing her to go to the nursing home since it would be a new and
unfamiliar place for the patient, making it harder for her to cope and remember things.

In that case, her family members can ensure there is always some form of identification on her in case she
gets lost, or even considering putting a GPS tracker on her. They can leave notes around the house, so she
does not get confused about little things, as well as leave a calendar and clock so the patient’s orientation of
time and space remains intact.